Should terminally ill patients have the right to kill themselves? Voters in Massachusetts will soon decide. Last Wednesday, the Secretary of the Commonwealth announced that on November 6, 2012, when Bay State voters go to the polls to pick the next President, they will also have their say on a ballot measure called the Death with Dignity Act. If passed, the law would make Massachusetts the third state to give adults diagnosed with six months or less to live the option to end their lives using a lethal dose of doctor-prescribed medication.

Last year, volunteers from across the state began a petition drive to collect the 68,911 signatures needed to introduce the act for consideration by the state legislature; by the time they were done, they’d gotten more than 86,000 voters to sign on to show their support. Lawmakers had until the beginning of May to address the issue, but they declined to do so. In response, volunteers fanned out for a second wave of signature gathering. An additional 21,000 people from the state’s 14 counties signed on to support the Act. That’s nearly double the number needed to bypass the statehouse and bring the issue directly to voters via ballot measure.

Oregon and Washington were the first states to enact Death with Dignity laws. (In Montana, the state’s Supreme Court ruled in 2009 that physician-assisted suicide was legal, but Montana has no guidelines in place to regulate and monitor the practice.) Since 1997, when Oregon’s Death with Dignity Act went into effect, more than 900 people have received prescriptions to their end their lives. Not all have used the drugs. The Oregon Public Heath Division reports that more than 600 individuals have taken the dose, while the remainder either decided against using the prescription, or succumbed to their diagnosed illness.

In Oregon and Washington, patients must first make two requests of their doctor for medication, fifteen days apart. The patient then has to make the request in writing. In order to prevent potential abuses, patients are required to sign consent forms in the presence of two witnesses to whom they are not related. Once approved, patients must self-administer the drugs. Typically, it’s a deadly dose of Seconal, a barbiturate often prescribed by doctors to treat insomnia or to calm patients before surgery. The contents of the capsules are stirred into a glass of water or a serving of applesauce, to dull the taste. Statistics compiled and released annually by the Oregon Department of Health show that in the majority of cases, people lose consciousness within five minutes of swallowing the drugs. It can take anywhere between one minute and four days to die, but for most people death comes in just 25 minutes.

Ninety-eight percent of people who have made use of the law in Oregon are white. Eighty-one percent had cancer. Fifty-two percent were men. The median age of those who died using the law was 71. Most patients were enrolled in hospice and privately insured. They cited loss of autonomy, loss of dignity and the fact that they were “less able to engage in activities making life enjoyable” as the top three end-of-life concerns. In Washington State, where a Death with Dignity Act was approved by ballot initiative in 2008, and went into effect the following year, patients fit a similar profile. According to the latest figures released by the state, 135 people have died from the lethal prescription. The Death with Dignity Act that will go before Massachusetts’s voters this fall is modeled after laws in place in Oregon and Washington.

A survey conducted in May by Western New England Polling Institute showed that 60 percent of Massachusetts’s voters supported the rights of terminally ill patients to legally obtain and ingest life-ending drugs. Still, the measure faces tough challenges from powerful factions within and beyond the state. The Massachusetts Medical Society opposes the Act. The American Medical Association does too. “Physician-assisted suicide is fundamentally incompatible with the physician’s role as a healer,” the AMA states in its Code of Medical Ethics. “Patients should not be abandoned once it is determined that cure is impossible.”

Disability-rights activists have also spoken out against physician-assisted suicide. So has the Catholic Church. Noting a resurgence of interest in the topic and a renewed push by advocates of physician-assisted suicide to extend the practice beyond Oregon and Washington, the United States Conference of Catholic Bishops last year issued an impassioned statement against the practice. In Massachusetts, the Roman Catholic Archdiocese of Boston, anticipating the ballot measure, created a website, suicideisalwaysatragedy.org. “Our society will be judged by how we treat those who are ill and infirm,” Archbishop of Boston, Cardinal Sean O’Malley, says in a video address that appears on the site. “They need our care and protection, not lethal drugs.”

But it’s the people of Massachusetts who will ultimately decide the law’s fate, not religious leaders, lawmakers or medical professionals. Dr. Marcia Angell, former editor of Massachusetts Medical Society’s New England Journal of Medicine, and one of the Act’s lead sponsors, puts little stock in what physicians have to say about the matter.

“I am less concerned with what doctors want than with what patients want,” Angell said in an interview that aired on WGBH, in Boston. She continued, “I think doctors sometimes have a too-narrow idea of what their own obligations are. They feel they have an obligation to extend life even when it can’t be extended significantly. And even if you have that situation, then it seems to me they have two obligations. One is to support the autonomy, the self-determination of their patients. And the other is to relieve suffering. If you can’t extend life significantly, then you must relieve suffering.”

A study released by the Health Research and Education Trust shows that Americans are living longer lives than ever before. As a result, more individuals and families will face difficult questions about end-of-life care. In 2011, the oldest Baby Boomers turned 65. By 2030, the number of Boomers between 66 and 84 years old will climb to 61 million, and six out of 10 will be managing chronic health conditions. For the elderly and others facing terminal illness, doctors have numerous ways to prolong life. Palliative and hospice care are available to help patients find peace and comfort in their final days. But there are some people who want another option, which is the right to end suffering by taking their own life at a time and place of their choosing.

Many of the religions practiced in the United States support a woman’s right to access reproductive health care, including abortion and contraception, as a matter of free exercise of conscience. The Catholic Church is the one of the few, if not the only religion that is fundamentally antithetical to any notion of women’s reproductive health, freedom, and justice. Unfortunately, the Catholic Church as represented by the U.S. Conference of Catholic Bishops, more than any other, directly influences American politics.

Take, for example, the controversy that has been raging for the past four months about President Obama’s contraception mandate. After Republicans lost their collective mind about access to contraception, whinging that President Obama was destroying the Constitution and the very fabric of society as we know it by daring to include women’s reproductive health under the rubric of the Affordability Care Act, President Obama offered an accommodation to religiously-affiliated employers that protested being required to offer birth control coverage as part of their insurance plans. The accommodation will allow such religiously-affiliated employers not to offer birth control; instead, insurance companies for those employers will have to reach out directly to employees and offer contraception coverage for free, without going through the employer. Writing about the accommodation, Amanda Marcotte noted that Obama had punked the GOP: “Obama just pulled a fast one on Republicans. He drew this out for two weeks, letting Republicans work themselves into a frenzy of anti-contraception rhetoric, all thinly disguised as concern for religious liberty, and then created a compromise that addressed their purported concerns but without actually reducing women’s access to contraception.”

In February – when Obama announced the accommodation – two entities on opposite sides of the birth control issue (Planned Parenthood and the Catholic Health Association) were satisfied. Sister Carol Keehan, the president and CEO of the Catholic Health Association (“CHA”), noted, “The Catholic Health Association is very pleased with the White House announcement that a resolution has been reached that protects the religious liberty and conscience rights of Catholic institutions.” She further noted that the accommodation adequately responded to the concerns of the CHA: “The framework developed has responded to the issues we identified that needed to be fixed. We are pleased and grateful that the religious liberty and conscience protection needs of so many ministries that serve our country were appreciated enough that an early resolution of this issue was accomplished. The unity of Catholic organizations in addressing this concern was a sign of its importance. This difference has at times been uncomfortable but it has helped our country sort through an issue that has been important throughout the history of our great democracy.”

Four months later, however, the CHA has reversed its position in what can only be described as a flip-flop of epic proportions. On Friday, the CHA sent a five-page letter to the Department of Health and Human Services stating that the accommodation no longer “adequately meet[] the religious liberty concerns.” Odd — that wasn’t CHA’s position four months ago.

Nonetheless, the CHA now claims that the contraception mandate — which exempts actual houses of worship, but not faith-based institutions like hospitals and schools that don’t primarily serve or employ people of the Catholic faith – should be further restricted, and that the exemption should be broadened to include hospitals and schools. Plainly, it is a purely political move. As Michelle Boorstein notes, the CHA’s about-face comes as just as polls show that Romney and Obama are tied among Catholic voters. (Four out of the five last presidential elections were won with the Catholic vote.)

Given that the U.S. Conference of Catholic Bishops and organizations like the Catholic Health Association play a critical role in American politics, the question becomes, then, for how much longer are we going to permit religion to have a place in our political discourse? And, at what point does the health and safety of American women become paramount to any issues of religious conscience? There is a clear and present danger that the health of American women – especially the health of minority and low-income women – will be subject to the political whims of the Catholic Church.

One stark example of this unholy union of political and religion is the increasing number of mergers between secular and Catholic hospitals. Hospitals throughout the country are struggling to remain solvent. As hospitals face increasing financial difficulty, mergers between secular and Catholic hospitals seem to be an oasis in a desert plagued by financial uncertainty. Certainly, such mergers seem to be a solution more desirable than closing hospitals. But at what cost?

Catholic hospitals are required to obey the U.S. Conference of Catholic Bishops’ list of ethical and religious directives. Often when Catholic hospitals merge with secular hospitals, the secular hospital is thus required to obey the ethical and religious directives of the Catholic Health. This means that many women’s healthcare services are no longer offered at the newly-formed hospital. Such services including abortions (even those that are medically necessary), birth-control, vasectomy and tubal ligation, and many kinds of infertility treatment. Additionally, Catholic hospitals specify how ectopic pregnancies must be treated, and that treatment differs from how they are treated in secular hospitals.

Such restrictive rules have a catastrophic effect on women in communities where the only option may be to obtain healthcare services at a newly merged hospital which finds itself suddenly required to follow Catholic religious and ethical directives or risk severe punishment. For example, in 2009, the ethics committee of St. Joseph’s Hospital and Medical Center, a hospital in Phoenix operated by Catholic Healthcare West, Phoenix voted to permit a medically necessary abortion to save the life of a woman (11-weeks pregnant) whose pulmonary hypertension would have killed her if she did not have an abortion. That hospital was later stripped of its Catholic access, and Margaret McBride, a nun on the ethics committee was automatically excommunicated — all because of a decision that almost certainly saved the life of a breathing already-alive woman. (As of December 2011, McBride has been returned to good standing, and is no longer excommunicated.)

The impact of the merger between Catholic and secular hospitals disproportionately and negatively impacts women, and in many cases, the merger debate becomes about whether a community is willing to sacrifice the health of women in order to promote economic and community growth or ensure that hospitals remain solvent. Such debates arise when a community attempts to merge a secular and Catholic hospital so that the newly-formed hospital can remain in compliance with religious and ethical directives while still offering “sinful” women’s health care services.

But even when such creative solutions are proposed, those solutions may not entirely assuage the fears of women’s health activists. For example, in Waterbury, Connecticut, a proposed hospital merger between two hospitals has sparked grave concerns among those who insist that the continuation of reproductive healthcare services must be a priority. St. Mary’s and Waterbury hospitals, and a for-profit company, LHP Hospital Group, plan to build a new 800,000 square-foot private hospital at a cost of $400 million, with each hospital having a ten percent stake. Additionally, the hospital seeks state approval for a separate “ambulatory” center which would be located near, but not inside the new hospital.

As Teresa Younger, the executive director of the Connecticut Permanent Commission on the Status of Women points out, “the agreement by LHP and Waterbury Hospital to follow the ethical and religious doctrines for a ten-percent owner of the facility is problematic.” Moreover, it I questionable as to whether requiring women who have undergone a C-section to visit a separate facility for a tubal ligation comports with the best “standards of practice.”

Mergers like the one being debated in Waterbury are occurring nationwide, and it seems that the health of women – many of whom are not Catholic in the first place – is being sacrificed at the behest of the Catholic Church. It is unacceptable. The tension between religious doctrine and women’s health should always be resolved on the side of women’s health, especially where, as here, the decision-making process of Catholic leaders seems entirely political and not conducted in good faith.

Jeri Orfali was a top software executive in the early days of Silicon Valley, author of several books and even professionally courted by Steve Jobs until, like Jobs, she was struck down with cancer at the age of 56.

“You don’t think about how someone dies from cancer,” said her husband of 30 years, Robert Orfali. “No one tells you what really happens. It took me by surprise, everything.”

The Orfalis settled in Hawaii, where his wife was eventually diagnosed with ovarian cancer and died in 2009. In her final days, she bore excruciating pain that was not helped by palliative care.

“In the end I could see tumors coming out of her legs and in her neck,” he said. “Her legs were swollen and her stomach was so bloated, the cancer almost burst out of her. She couldn’t get her next breath.”

There is no dignity in dying, according to Orfali, who was so horrified by his wife’s suffering that he wrote two books on the topic and has pushed to see Hawaii be the fourth state to legalize physician-assisted death.

And now, experts working with the national group, Compassion and Choices, and the Hawai’i Death With Dignity Society, have unearthed a 102-year-old provision in Hawaiian law that they say means aid in dying has been legal all along:

[W]hen a duly licensed physician or osteopathic physician pronounces a person affected with any disease hopeless and beyond recovery and gives a written certificate to that effect to the person affected or the person’s attendant, nothing herein shall forbid any person from giving or furnishing any remedial agent or measure when so requested by or on behalf of the affected person.”

Advocates say the provision was added in 1909 to give dying patients the option to get treatment that may not have been approved by the government. It likely arose out of now- canonized Father Damien’s missionary work on the Island of Molokai with those who suffered from leprosy.

Some retired doctors now say they are poised to go ahead and help those who seek aid in dying, provided they meet guidelines established by a law in Oregon, where doctors have been legally allowed to end a terminal patient’s suffering since 1997.

Since then, Washington and Montana have also legalized aid in dying.

“I think there is very little risk on my part if I did that,” said Dr. Robert “Nate” Nathanson, 77, a retired general practitioner from Oahu, who said he has kept his medical license current so he could test the existing law. “If you qualify and your own doctor won’t do it, I would be willing.”

Nathanson and Orfali were part of a recent forum on that legal provision and have been advocates for what they call “death with dignity.”

Advocates say that just having the lethal pills gives terminally ill patients peace of mind that they can control their lives and their death.

“I like the term ‘death with dignity’ — it is much better than physician-assisted suicide, which conjures up a person who is depressed and kills themselves,” said Nathanson.

Their loudest critics — right-to-life groups, the Catholic Church and those who represent the disabled — say Compassion and Choices, a national group that grew out of the former Hemlock Society, is spreading “misinformation.”

“Oops, they did it again,” responded the president of the Aloha Life Advocates, Karen DiCostanzo, in the Hawaii Reporter.

The advocacy group claims what they call “physician-assisted suicide” would be a “recipe for elder abuse.”

“The ‘panel’ consisted solely of suicide activists, so this was not a bona fide effort to air opinions from both sides and maintain balance,” DiCostanzo wrote. “Rather, this was meant as a PR stunt to create a news story and arouse public interest in their cause.”

She contends that the 1909 provision was written to allow doctors to give patients nontraditional remedies for illnesses such as Hansen’s disease (leprosy), tuberculosis and asthma.

Though she assails their argument as “weak,” DiCostanzo urges Hawaiians to “act now” to prevent Hawaii from going the route of three other states that give a physician the freedom to prescribe fatal medication to mentally competent patients who are terminally ill without fear of prosecution.

The Catholic Church was one of the groups that derailed an effort in 2002 to legalize assisted death in Hawaii. The bill, which had been introduced by Democratic then-Gov. Benjamin Cayetano and passed the state House of Representatives, was defeated 14-11 vote in the state Senate.

“What strikes me as so ironic about the movement for physician-assisted suicide — is that it is portrayed as a movement to affirm individual freedom and autonomy,” said the Bishop of Honolulu Clarence (Larry) Silva in an email to ABCNews.com. “However, the fact of the matter is that people have been committing suicide quite autonomously for millennia, without the help of physicians.

“The fact that the proposed laws require informed consent before a lethal dose can be prescribed indicates to me that in the depths of their hearts people know that suicide is wrong,” he said. “They seem to want a way to convince themselves that it is acceptable by having a ‘higher authority’ authorize it.”

He said suicide is “always a tragedy” and hurts family and friends who are “left behind,” leaving them with grief and “lasting guilt.”

But advocates for aid in dying say that end-of-life care is sometimes inadequate.

Orfali, who described his devotion to his wife as “love on steroids,” said her last days were agonizing when morphine and two other standard medications were unable to alleviate her pain.

She had been a champion surfer in her age class throughout chemotherapy, but in the end, “nothing worked,” even with the palliative care of hospice, he said.

Hospice care varies, according to Nathanson, who was one of the founders of two hospices in Hawaii. “They belong to a national association, but they make their own rules.”

Some allow “terminal sedation” — that is, giving an intravenous cocktail of drugs that depress respiration and hasten death — but others do not.

But terminal sedation is under a doctor’s control, according to Nathanson, and “the patient has no say in it.”

Critics of Oregon’s law have used the “slippery slope” argument that “people would come from miles around to get medicine and we would be bumping off the elderly and the poor,” he said, but that never materialized.

According to a report from the Oregon Department of Human Services, 95 prescriptions for lethal medications were written in 2010, compared to 88 during the previous year. Of those, 59 patients took the medications.

“There is also an incredible paradox here,” said Nathanson. “The people you end up writing a prescription for may end up living longer than expected. … They didn’t have the toxic anxiety that eats at you.”

As for Orfali, he said that had his wife been able to get a prescription for the Nembutal, the drug used in Oregon, she would have been spared so much suffering.

Jeri Orfali even ordered lethal medication on the Internet, but never used it.

“She really wanted pills as a backup, but she was too afraid to use them,” said her husband.

Medication obtained online often isn’t strong enough to induce death and a family member needs to be nearby to “finish off the job,” according to Orfali.

“She was a nonviolent person,” he said. “The last thing she wanted me to do was to put a bag over her head.

“She told me on her way out, ‘This doesn’t make sense to me in this condition. Can I try like in Oregon? That was the only thing she asked me in the end,” Orfali said.

Eventually, Jeri Orfali was given terminal sedation, but she endured 16 hours of tortured breathing before she had a blood clot and her lungs collapsed.

“It was like watching someone water boarded in front of you,” said Orfali, who wrote two books on the topic, “Death with Dignity,” and, “Grieving a Soulmate.” Meanwhile, he wonders about Steve Jobs’ death of respiratory failure just two weeks ago and whether he suffered as Jeri Orfali did.

“Everyone talked about how great things were and how he lived a great life. But did he have a good death?” asked Orfali. “Death is an ugly thing.”

]]>http://www.compassionandchoices.org/2011/10/27/retired-doctor-tests-aid-in-dying-law-in-hawaii/feed/0Sierra Vista Chooses Community Over Catholicismhttp://www.compassionandchoices.org/2011/04/04/sierra-vista-chooses-community-over-catholicism/
http://www.compassionandchoices.org/2011/04/04/sierra-vista-chooses-community-over-catholicism/#commentsMon, 04 Apr 2011 23:20:05 +0000http://blog.compassionandchoices.org/?p=1422... more]]>Last week Sierra Vista Hospital, in rural Southeast Arizona, abandoned its affiliation with the Catholic Carondelet Health Systems. One year into a 2-year trial period, reality apparently hit home. The hospital board could no longer ignore daily picketing by concerned citizens, growing discontent of physicians barred from delivering high quality medical care and mounting evidence that strict doctrinal enforcement undermines a community’s trust in its medical provider. An informative PBS story (see the bottom of this post for the video) 4 days prior may have influenced board members as well.

Compassion & Choices supporters were especially concerned that end-of-life wishes be heeded and honored. Thus, we enthusiastically join Cochise Citizens for Patient Choice in celebrating this victory for quality care and patient self-determination. I hope this signals the start of a trend among hospitals to avoid mergers binding them to religious doctrine.

Over the last century Catholic institutions grew, prospered and assumed an ever greater market share in the healthcare industry. Today more than 600 Catholic hospitals deliver care to 1 in 6 patients in the United States each year. Since 1971 these hospitals have followed written doctrinal direction from the National Conference of Catholic Bishops, which in turn follows the Vatican.

A publication called Ethical and Religious Directives for Catholic Healthcare (ERD) lays it all out. Until recently hospitals could interpret the ERD according to their own conscience, and they usually found ways to meet the needs and expectations of their communities. But the local bishop is final decision-maker and an increasingly conservative hierarchy is flexing its doctrinal muscle across the nation. This leaves hospitals with a stark choice: buckle under pressure from Catholic authority or break the shackles of Vatican oversight.

The tension plays out in different ways.

Last May Bishop Olmstead of Phoenix terminated the church’s 116-year relationship with St. Joseph’s Hospital for terminating a woman’s pregnancy to save her life. The hospital, its parent corporation, Catholic Healthcare West, and the Catholic Health Association all backed the decision of Sister Margaret McBride, who led the hospital’s ethics committee. Now she is excommunicated, Mass no longer occurs in the hospital chapel, and the community knows its hospital will not allow Bishop Olmstead to obstruct a life-saving procedure.

Similarly, St. Charles hospital in Bend, Oregon, refused to accede to demands from Bishop Robert Vasa to stop performing tubal ligations for women seeking to limit their pregnancies. Founded by nuns 92 years ago, St. Charles is no longer a Catholic health center and delivers about 250 tubal ligation services per year.

But in Texas, Bishop Alvara Carrada stopped tubal ligations at St. Michael’s and Trinity Mother Frances Hospital in 2009. Now women who give birth there by caesarean section must endure the risks and inconvenience of a second surgery, at a different facility, to have their tubes tied. Exposing patients to unnecessary surgical risk falls below the standard of care in every community.

For Compassion & Choices, the chief hazard of the ERDs is the stipulation that advance directives are valid so long as their instruction does not conflict with Catholic teaching. Since the local bishop interprets and enforces Catholic teaching, it’s uncertain how a person’s wishes might be viewed should the need arise. Compassion & Choices offers a Dementia Provision as an advance directive addendum, and it seems almost certain to run afoul of recent Catholic teaching on tube feeding.

Catholic dogma and community medical expectations are on a collision course. Hospitals serving diverse communities cannot shoulder the weight of strict ERD enforcement as America’s population ages and vests itself in end-of-life choice and control, as new technologies to treat infertility emerge and as therapies developed with embryonic stem cell cultures come on line.

To me, the most striking aspect of these events is how totally tone deaf Catholic leaders are to growing disenchantment with their edicts. They care not at all that Catholic hospitals deliver healthcare to Lutherans, Presbyterians, Jews, Muslims, Buddhists and Atheists as well as Catholics. They demand Catholic doctrinal adherence from all.

The PBS story features Bishop Weinandy, executive director for the Secretariat of Doctrine, and Richard Dorflinger, Associate Director, Secretariat of Pro-Life Activities, both at the US Conference of Catholic Bishops. Weinandy defends Bishop Olmstead’s preference for a woman’s death over a pregnancy termination with this: “If you directly said the mother could not live unless we aborted the child then that would be contrary to Gospel values and the teaching of the church.”

That may be a reason enough for Weinandy and Dorflinger, but it shocks the conscience of most Americans and conflicts with their expectations for responsible health care. The Washington Post offers an example from the ranks of Catholic moral theologians. It cites Rev. James Bretzke of Boston College, “who supports the directives but said he might now hesitate if a female relative sought some care at a Catholic hospital.”

When Reverend Bretzke’s hesitation spreads to a critical mass of alert healthcare consumers, as it did in Sierra Vista, I predict Catholic healthcare institutions will do the right thing. In increasing numbers they will reject their assigned role as enforcer of Vatican doctrinal ideology, and serve their communities instead. If not, purchasers of healthcare — patients, employers and insurance carriers — will shun them in the marketplace, preferring providers unencumbered by obedience to dogma that harms patients.

]]>http://www.compassionandchoices.org/2011/04/04/sierra-vista-chooses-community-over-catholicism/feed/1Feedings Tubes For All — The Bishops Know What’s Best for Youhttp://www.compassionandchoices.org/2009/12/10/feedings-tubes-for-all-the-bishops-know-whats-best-for-you/
http://www.compassionandchoices.org/2009/12/10/feedings-tubes-for-all-the-bishops-know-whats-best-for-you/#commentsThu, 10 Dec 2009 20:42:26 +0000http://compassionandchoices.org/blog/?p=793... more]]>The enforcement arm of the Catholic Church has ordered feeding tubes to be inserted in all comatose and vegetative patients in Catholic institutions and maintained indefinitely. Compassion & Choices has warned of the impa How To Get Your Your Ex Boyfriend Back ct this will have on your healthcare choices. I want to make clear the sources of the outrage I expressed in my last blog.

I understand the history and spirit of sectarian health care, and I feel open and accepting of its role in America. In the 1970’s I practiced as a physician assistant in a Seventh Day Adventist healthcare system and I delivered both my children in its hospital. I truly appreciated the staff’s attitude of spiritual calling and the prayers they offered for my safety and my babies’. True, those awful soy patties from cans almost turned me away from vegetarianism for life. But it seemed to me the Adventists ranked service and humility ahead of doctrine and I never saw their religion dominate a conversation or a medical decision.

The ERD’s are different. They are all about dominance. Four aspects are especially chilling in their authoritarian pronouncement.

First, the Bishops explicitly target everyone, of every faith, with the “revealed truth” reflected in their ERD’s. The document specifically directs its mandates beyond hospital employees and Catholics, to every patient, resident or recipient of Catholic services. Everyone — Buddhist, Muslim, Jewish, Protestant or Unitarian — must obey.

Fourth, many find shocking the exaltation of suffering as “participation in the redemptive power of Christ’s passion“. And few non-Catholics find comfort in Directive #61. There we find that dying patients “experiencing suffering that cannot be alleviated should be helped to appreciate the Christian understanding of redemptive suffering.” Apparently the nurses are to deliver a theology lesson to patients dying in agony.

The ERD’s demonstrate that one purpose of Catholic health care is to coerce people of all faiths into following Catholic moral teachings. Employers facilitate the coercion when the only health plan they offer is Catholic. States facilitate the coercion when they approve hospital mergers rendering large geographic areas devoid of any but Catholic health care. Insurers facilitate the coercion when they fail to offer a broad choice of providers within their coverage.

My sense is the feeding tube mandate finally crossed a line, where states, employers, and insurers will no longer be willing to participate in the coercion. Personal dignity, individual right of conscience and autonomy in healthcare decisions are too important to continue to pretend Catholic healthcare is not prejudicial and discriminatory against non-Catholics.